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What are the risk factors for osteosarcoma?

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors.

Lifestyle-related risk factors such as body weight, physical activity, diet, and tobacco use play a major role in many adult cancers. But these factors usually take many years to influence cancer risk, and they are not thought to play much of a role in childhood cancers, including childhood osteosarcomas. So far, lifestyle-related factors have not been linked to osteosarcomas in adults, either.

Age

The risk of osteosarcoma is highest for those between the ages of 10 and 30, especially during the teenage growth spurt. This suggests there may be a link between rapid bone growth and risk of tumor formation. The risk goes down in middle age, but rises again in older adults (usually over the age of 60). Osteosarcoma in older adults is often linked to another cause, such as a long-standing bone disease.

Height

Children with osteosarcoma are usually tall for their age. This also suggests that osteosarcoma may be related to rapid bone growth.

Gender

Osteosarcoma is more common in males than in females. Females tend to develop it at a slightly earlier age, possibly because they tend to have their growth spurts earlier.

Race/ethnicity

Osteosarcoma is slightly more common in African Americans than in whites.

Radiation to bones

People who were treated with radiation therapy for another cancer might have a higher risk of later developing osteosarcoma in the area that was treated. Being treated at a younger age and being treated with higher doses of radiation both increase the risk of developing osteosarcoma.

It is not clear if imaging tests that use radiation, such as x-rays, CT scans, and bone scans, raise the risk of developing osteosarcoma. The amount of radiation used for these tests is many times lower than that used for radiation therapy. If there is any increased risk it is likely to be very small, but doctors try to limit the use of these types of tests in children whenever possible, just in case.

Certain bone diseases

People with certain non-cancerous bone diseases have an increased risk of developing osteosarcoma.

Paget disease of the bone: In this condition, abnormal bone tissue forms in one or more bones. It mostly affects people older than 50. The affected bones are heavy and thick but are weaker than normal bones and are more likely to break. Usually this condition by itself is not life-threatening. But bone sarcomas (mostly osteosarcoma) develop in about 1% of people with Paget disease, usually when many bones are affected.

Hereditary multiple osteochondromas: Osteochondromas are benign bone tumors formed by bone and cartilage. Each osteochondroma has a very small risk of developing into a bone sarcoma (most often a chondrosarcoma, but less often it can be an osteosarcoma).

Most osteochondromas can be cured by surgery. However, some people inherit a tendency to develop many osteochondromas starting at a young age, and it may not be possible to remove them all. The more osteochondromas a person has, the greater the risk of developing a bone sarcoma.

Inherited cancer syndromes

People with certain rare, inherited cancer syndromes have an increased risk of developing osteosarcoma.

Retinoblastoma is a rare eye cancer of children. Some children have the inherited form of retinoblastoma (hereditary retinoblastoma), in which all the cells of the body have a mutation (change) in the RB1 gene. These children also have an increased risk of developing bone or soft tissue sarcomas, including osteosarcoma. If radiation therapy is used to treat the retinoblastoma, the risk of osteosarcoma in the bones around the eye is even higher.

The Li-Fraumeni syndrome makes people much more likely to develop certain types of cancer, including breast cancer, brain tumors, osteosarcoma, and other types of sarcoma. This syndrome is usually caused by a mutation of the TP53 tumor suppressor gene.

Children with Rothmund-Thomson syndrome are short and tend to have skeletal problems and rashes. They also are more likely to develop osteosarcoma. This syndrome is caused by abnormal changes in the REQL4 gene.

Other rare inherited conditions, including Bloom syndrome, Werner syndrome, and Diamond-Blackfan anemia, have also been linked to an increased risk of osteosarcoma.